Over-the-counter (OTC) drug coverage list
Defines coverage for certain OTC medications (allergies, indigestion, heartburn) when prescribed by a provider and filled at an in-network pharmacy for members of Southeast Michigan Partners and Western Michigan Partners plans.
No material clinical or coverage changes in this revision.
Policy Snapshot
Defines coverage for certain over-the-counter (OTC) medications (allergies, indigestion, heartburn) when prescribed by a provider and filled at an in‑network pharmacy for members of Southeast Michigan Partners and Western Michigan Partners plans. Coverage is provided with a Tier 1b copayment as shown on the member's Schedule of Copayments and Deductibles. Listed products include nasal and oral therapies such as FLUTICASONE PROPIONATE, CETIRIZINE HCL, FAMOTIDINE, and LORATADINE; this is not a complete list, and members should refer to the Approved Drug List at priorityhealth.com/formulary and their plan documents for full, up-to-date coverage and any exclusions. Last review: Dec 2024.
When OTC Drugs Are Covered
Coverage eligibility criteria
Conditions that must be met for an OTC drug to be covered
ALL of the following
- Medication is an OTC product listed as covered by the plan (e.g., certain allergy, indigestion, heartburn drugs)
- Medication is prescribed by a provider